ry ry . Dr. N. Ravindra Shetty Orthopaedic Surgeon, discussing - PowerPoint PPT Presentation

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Dr. N. Ravindra Shetty Orthopaedic Surgeon, discussing Anyuta - Pilot Project – Karnataka, with Honorable President of India Abdul J. Kalam, at Bangalore on 20th August 2005,

COST DIFFERENCE Name e of the Illne ness Hospita tal Bill Specialt ialty Super r Specialt ialty Differen erence Patient ient Apollo BGS Narayana Jayadeva Kidwai Nephro Urology Medical College hospitals

Please se check every ery file for all the criter eria written en here e under Check eck List for Policyhol yholder der Policy y Details Hospital Details. Main Bill. 1. Policy y Cop 1. Name the Primary Doctor. 1. Break up of Final Bill. (Sum Insured red / validity) y) (Mobile/ Landline Number/ E – mail / Website) 2. Claim Form. 2. Name the Specialists. 2. Receipts of all bills. (Sign gned ed by Policyhol holder) der) (Mobile & Landline Number) (Signed by the Doctor / Patient) 3.Cop opy y of the ID Card. 3. Investigations ordered and the Reports - Signed by Specialists in the Specialty. 3. Advance paid receipt. (Name, Qualification, Registration number) 4. Name e of the Insurance e Co. 4. Doctor’s Prescription / dispensed Medicine Bill 4. Anyuta – Payment details. (Signed by the qualified Pharmacist (Name, Qualification, Registration number) 5. Zone/ e/Divi visi sion on/Bra ranch 5. Discharge Summary in Anyuta Format 5. Covering letter. (Diagnosis, ICD Code, Treatment given, Follow up instructions) 6. Con ontact number. ber. 6. Contact number. 6. Contact number. 7. E- Mail addres ess. s. 7. E- Mail address. 7. E- Mail address. 8. Policy y Limit 8. Pre – authorization request - Copy 8. Discount Offered 9. Anyuta TPA Authorization Letter for Cashless facility - Copy

ANYUTA - TPA ABY Claim Settlem emen ent Format : PLEASE MENTION CCN REIMBURSEMENT/CASHLESS PLEASE MENTION PREVIOUS CLAIM DETAILS ( IF ANY) Total Sum insured REIMBURSEMENT Available Balance HOSPITAL NAME CLAIMED DOA DOD 0 Room Stay 0 CLAIMED AMOUNT RS./-, BILLS / MEMOS ATTACHED ICU Stay 0 0 0 0 RS.0/-, PAID BY PARTY RS.REIMBURSEMENT/-. CODE DATE BILL NO SERVICES CLAIM DISCOUNT DEDUCTION PAYABLE DOCTOR'S REMARK Name Age / Sex Employ oymen ent No. Aadaha haar Card Number er Contact No Summary Diagnos nosis Treatmen ent given Procedur edure e done Cost incurred ed Doctor ors Fee Medicine ne Surgical Sundries es Medical sundries es CGHS Medicine ne Code CGHS Investigation on Code CGHS Blood d Test Code Implant nts Total Cost Packa kage e CGHS Code Packa kage e Rate Signatur ure e of the Hospital author ority

NOTE: CGHS has separate e rates for Consul ultation/ on/ Investigation on / Procedur dure/ e/ Medicine ne/ ICU and room. Reque uest the Hospital to apply CGHS rates for Consul ultation/ on/ Inves estigation on / Procedu edure/ e/ Medicine ne/ ICU / room and send the bill for Claim processing ng and settlem emen ent. Reque uest the Hospitals to send the Doctor`s `s Ethical Certificate e to justify fy, admission, on, investigation, n, medication, on, procedur dure e and the Costs. Anyuta Format is enclos osed ed here with for you to send it to all empane neled ed hospitals. With this method d there will not be any delay in claim processing ng and settlem emen ent. This will also o save e revenu enue e for the ABY Scheme. e. Settled Sl. No Name Procedure done Claimed Amount Hospital Remarks Amount The Bill states the Procedure is SPONSORED Please find out from the Hospital who was the SPONSORER and has he paid in full. Elective Coronary Artery Bypass CGHS has separate rates for Consultation/ Investigation Narayana 1 Ashok B Wajre Grafting X LIMA - OM, RSGV- / Procedure/ Medicine/ ICU and room. Hrudayalaya LAD/PDA/ PLV Request the Hospital to apply CGHS rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and send a fresh bill for Claim processing and settlement. Can be settled CGHS has separate rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room. Conservative Line Of 2 Revanna H N Mangala Hospital Treatment Request the Hospital to apply CGHS rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and send a fresh bill for Claim processing and settlement.

This for chronic renal al fai ailure for Hae aemodial alysis. Chronic disease needs repeated admission and treatment and sometimes life long, like kidney failure / Cancer/ Heart disease / Neurological disorder 20 20 Shiv Shankar r Gowda CS CS Dialys ysis Appol olo Haemodialysis @ Basic Cost + 20% Our advice is negotiate with the hospital for a package rate as mentioned above Haemodialysis @ Basic Cost + 20% Shakunthala Memorial Cancer @ @ Basic Cost + 20% 21 21 Tanuja Kolkar Dialysis Hospital & research Centre Our advice is negotiate with the hospital for a package rate as advised above Can be settled Medical 22 22 Dakshayani BGS Global Hospital Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ management Investigation / Procedure/ Medicine/ ICU and room and settle the Claim Can be settled 23 23 Ganesh Krupa V MRI-Spine Suguna Hospital Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim DJ Stent Removal Under LA. Could have been done as an outpatient procedure? We need doctor’s ethical certificate to process DJ Stent Removal 24 24 Gopal Krishna Suguna Hospital This file ethical certificate enclosed email. Under LA None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) Could this have been treated as Outpatient? We want doctor`s ethical certificate for justify investigation of the cost to process and Conservative Line settle the claims. 25 25 Gowrishree Suguna Hospital Of Treatment None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) Conservative Line None can interfere with the Treatment. But doctor should justify his Patient 26 26 Gururaja Raos N Apollo BGS Hospital Of Treatment Management ( admission and treatment line and costs)

Can be settl tled Medica cal Request est the Hospit pital to send a bill applyi ying g CGHS Code and rates s for 27 27 Jayalaksh shmi G S M Managem gemen ent Consu sulta tati tion on/ / Investi estiga gati tion on / Proce cedure/ / Medicine/ / ICU and room and settl tle the Claim Patient was admitted for 5 days and expired. Apollo BGS 28 28 Jayamma The total bill amount is 1,43,380/- Hospital We advise to request the hospital to reduce the cost. Can be settled Hitech Kidney Request the Hospital to send a bill applying CGHS Code and rates for 29 29 Padmaja K 1 ESWL Lithotripsy stone Hospital Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim Discharge against medical advice We need an Ethical certificate signed by the primary physician who admitted patient stating the admission was needed and the cost is 30 30 Padmaja K 2 Flush Therapy Suguna Hospital Genuine. None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) Can be settled Medical Request the Hospital to send a bill applying CGHS Code and rates for 31 31 Ranganath Suguna Hospital Management Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim Patient is admitted for Right Ureteric Calculi We want doctor`s ethical certificate for justify investigation of the cost to Bilateral stenting process and settle the claims. 32 32 Shankar M R Suguna Hospital Under SA None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs) Can be settled Medical Request the Hospital to send a bill applying CGHS Code and rates for 33 33 Sundar M R Management Suguna Hospital Consultation/ Investigation / Procedure/ Medicine/ ICU and room and settle the Claim Patient admitted on 18/10/12 discharge 19/10/12 against medical advice. Medical Venkata BGS Global We need doctor`s ethical certificate for justify investigation of the cost to 34 34 Management process and clear the bill. Krishnaiah Hospital None can interfere with the Treatment. But doctor should justify his Patient Management ( admission and treatment line and costs)